Chest Disease and Tuberculosis, Faculty of Medicine, Menoufia University, Shibin Al Kawm, Egypt.
Internal Medicine, Rheumatology and Clinical Immunology Unit, Faculty of Medicine, Menoufia University, Shibin Al Kawm, Egypt.
BMC Pulm Med. 2023 Apr 19;23(1):131. doi: 10.1186/s12890-023-02404-9.
Autoimmune rheumatic diseases (ARD) are groups of diseases that are commonly associated with cardiac and pulmonary manifestations and may affect the morbidity and mortality of the patients. The study aimed to the assessment of cardiopulmonary manifestations and their correlation with the semi-quantitative scoring of high-resolution computed tomography (HRCT) in ARD patients.
30 patients with ARD were included in the study (mean age 42.2 ± 9.76 years) [10 patients were scleroderma (SSc), 10 patients were rheumatoid arthritis (RA), and 10 patients were systemic lupus erythematosus (SLE)]. They all met the diagnostic criteria of the American College of Rheumatology and underwent spirometry, echocardiography, and chest HRCT. The HRCT was assessed by a semi-quantitative score for parenchymal abnormalities. Correlation between HRCT lung scores and: inflammatory markers, lung volumes in spirometry, and echocardiographic indices has been performed.
The total lung score (TLS) by HRCT was 14.8 ± 8.78 (mean ± SD), ground glass opacity score (GGO) was 7.20 ± 5.79 (mean ± SD) and fibrosis lung score (F) was 7.63 ± 6.05 (mean ± SD). TLS correlated significantly with ESR (r 0.528, p 0.003), CRP (r 0.439, p 0.015), PaO2 (r -0.395, P 0.031) FVC% (r -0.687, p 0.001), and echocardiographic Tricuspid E (r -0.370, p 0.044), Tricuspid E/è (r -0.397,p 0.03), ESPAP (r 0.459,p 0.011), TAPSE (r -0.405, p 0.027), MPI-TDI (r -0.428, p 0.018) and RV Global strain(r -0.567, p 0.001). GGO score correlated significantly with ESR (r 0.597, p 0.001), CRP (r 0.473, p 0.008), FVC% (r -0.558, p 0.001), and RV Global strain(r -0.496, p 0.005). F score correlated significantly with FVC% (r -0.397, p 0.030), Tricuspid E/è (r -0.445, p 0.014), ESPAP (r 0.402, p 0.028), and MPI-TDI (r -0.448, p 0.013).
The total lung score and GGO score in ARD were found to be consistently significantly correlated with FVC% predicted, PaO2, inflammatory markers, and RV functions. Fibrotic score correlated with ESPAP. Therefore, in a clinical setting, most clinicians who monitor patients suffering from ARD should concern with the applicability of semiquantitative HRCT scoring in clinical practice.
自身免疫性风湿病（ARD）是一组通常与心脏和肺部表现相关的疾病，可能会影响患者的发病率和死亡率。本研究旨在评估 ARD 患者的心肺表现及其与高分辨率计算机断层扫描（HRCT）半定量评分的相关性。
本研究纳入了 30 名 ARD 患者（平均年龄 42.2±9.76 岁）[10 名患者为硬皮病（SSc），10 名患者为类风湿关节炎（RA），10 名患者为系统性红斑狼疮（SLE）]。他们均符合美国风湿病学会的诊断标准，并进行了肺功能检查、超声心动图和胸部 HRCT。采用半定量评分法评估肺实质异常。分析 HRCT 肺评分与：炎症标志物、肺功能检查中的肺容积和超声心动图指标之间的相关性。
HRCT 的总肺评分（TLS）为 14.8±8.78（均值±标准差），磨玻璃影评分（GGO）为 7.20±5.79（均值±标准差），纤维化肺评分（F）为 7.63±6.05（均值±标准差）。TLS 与 ESR（r=0.528，p=0.003）、CRP（r=0.439，p=0.015）、PaO2（r=-0.395，p=0.031）、FVC%（r=-0.687，p=0.001）和超声心动图的三尖瓣 E 波（r=-0.370，p=0.044）、三尖瓣 E/è 比值（r=-0.397，p=0.030）、右心房压（r=0.459，p=0.011）、三尖瓣环收缩期位移（r=-0.405，p=0.027）、心肌斑点追踪技术的组织多普勒指数（r=-0.428，p=0.018）和右心室整体应变（r=-0.567，p=0.001）显著相关。GGO 评分与 ESR（r=0.597，p=0.001）、CRP（r=0.473，p=0.008）、FVC%（r=-0.558，p=0.001）和右心室整体应变（r=-0.496，p=0.005）显著相关。F 评分与 FVC%（r=-0.397，p=0.030）、三尖瓣 E/è 比值（r=-0.445，p=0.014）、右心房压（r=0.402，p=0.028）和心肌斑点追踪技术的组织多普勒指数（r=-0.448，p=0.013）显著相关。
ARD 患者的总肺评分和 GGO 评分与 FVC%预测值、PaO2、炎症标志物和 RV 功能显著相关。纤维化评分与右心房压相关。因此，在临床实践中，监测 ARD 患者的大多数临床医生应关注半定量 HRCT 评分在临床实践中的适用性。
